Routine inspection·July 8, 2024

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Administrator (AD) Shirley Natividad and discussed the purpose of the inspection. LPA reviewed Infection Control requirements. At about 9:30AM, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: facility is a 7-bedroom, 3-bathroom, two-story house with attached garage that is used for storage. There is a back yard with a patio cover for the residents. LPA and AD observed 3 staff and 6 residents present at the facility. Resident Bedrooms: the 3 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: LPA inspected the 4 staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 105 degrees F in the common resident bathroom and 109.7 degrees in the private resident bathroom. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. Facility’s licensing fees are paid. At about 8:00AM, LPA reviewed 6 resident files and 3 staff files, interviewed 3 residents and 2 staff, and inspected medications for 6 residents. Facility does not handle resident money. CONTINUED During the inspection, LPA and AD observed the following: based on observation and admission, the facility's fire clearance shows one large staff bedroom on the second floor but the facility divided the bedroom into four staff bedrooms without obtaining a new fire clearance; based on observation, the facility does not have the personal rights posted; based on documents, the licensee did not ensure the medications of 6 out of 6 residents were tracked by not using a Medication Administration Record (MAR); and based on observation and admission, the facility has two stories with only staff living upstairs but does not have an evacuation chair Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.